Bipolar Disorder

Interested in participating in a bipolar disorder study?

Fill out the form below to see if you qualify.

First Name*

Last Name*


Phone Number*

Have you ever been diagnosed with Bipolar Disorder?
YesNoNot sure

If yes, what type?

​Are you currently experiencing a depressive episode?

If yes, how long has this CURRENT period of depression been going on?

​When was the last time you had a manic episode (period of hyperactivity lasting 3 or more days)?
CurrentlyWithin the past monthA couple months ago4+ months ago

Have you ever attempted suicide?

​​-If you answered yes, when was the last time you attempted suicide?

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